Organization
UNIVERSITY DERMATOPATHOLOGY CONSULTANTS PSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANINE C MALONE M.D. (PRESIDENT)
(502) 569-7711
Entity
Organization
Contact information
Practice address
310 E BROADWAY, SUITE 3A, LOUISVILLE, KY 40202-1745
(502) 569-7711
(502) 587-8119
Mailing address
310 E BROADWAY, SUITE 3A, LOUISVILLE, KY 40202-1745
(502) 569-7711
(502) 587-8119
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
KY32113
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200919370A
—
IN
01
—
3539028000
PASSPORT ADVANTAGE
KY
01
—
50020526
PASSPORT
KY
05
—
7100062460
—
KY
01
—
DP2238
MEDICARE RR
KY
Enumeration date
03/13/2008
Last updated
01/08/2010
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